ALKALINE BUFFERS FOR CORRECTION OF METABOLIC-ACIDOSIS DURING CARDIOPULMONARY-RESUSCITATION WITH FOCUS ON TRIBONAT(R) - A REVIEW

A combined hypercarbic and metabolic acidosis develops during the low flow state of cardiac arrest treated with cardiopulmonary resuscitatio n. Several negative consequences of the acidosis have been demonstrate d, two of the most important being reduced contractility of the ischae mic but still beating myocardium and impaired resuscitability of the a rrested heart. Even though interventions to re-establish a spontaneous circulation should be the number one priority during cardiopulmonary resuscitation, attempts to treat the acidosis are often carried out in order to avoid the reported negative inotropic effect. Different alka line buffers have been used, but it has been demonstrated over the yea rs that such treatment may aggravate the situation due to a variety of deleterious side-effects of the buffers. A mixture of THAM, acetate, sodium bicarbonate and phosphate registered as Tribonat(R) has been su ggested as a suitable alternative to conventional buffer substances. T he problems preceding the designation of Tribonat(R) as well as studie s evaluating its effects are reviewed in this article. Tribonat(R) see ms to offer a more well-balanced buffering without any major disadvant ages compared with previously used alkaline buffers, even though impro ved survival has not been reported. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.